1768 



HELMINTH INFECTIONS 



Mental and physical hebetude are marked, and other nervous 

 symptoms may be observed. Children do not develop properly, 

 and sterility, with delayed menstruation, has been noted. 



When the ansemia becomes profound death may ensue from 

 cardiac failure, but any intercurrent affection hastens the end in a 

 case of ankylostomiasis. 



Complications. — Any intercurrent disease is a serious complica- 

 tion, as also is pregnancy. 



Diagnosis.' — The definite diagnosis depends upon finding the ova 

 in the faeces. 



Anaemia in tropical countries, especially if associated with 

 dropsy, should at once lead the practitioner to suspect ankylosto- 

 miasis. It must be remembered, however, that it is by no means 

 easy to find the ova in the faeces at the first examination, and that 

 sometimes, even in the worst cases, they require to be looked for 

 on several days. Occasionally it is useful to give an aperient to 

 make the eggs appear in the stools. 



To facilitate the search for the eggs in the stools several methods have been 

 elaborated by Fiilleborn, Pepper, and others. Pepper's method is based on 

 the stickiness of the ova; a portion ©f the sedimented faeces is placed on a 

 slide for a few minutes, and then gently immersed in water; after this, 

 although all other materials are washed away, the ova still adhere to the slide. 

 If this process is repeated several times, numerous eggs may accumulate on 

 the slide. It is to be noted that eggs of A scaris, Trichuris, etc., do not possess 

 this physical property, and therefore do not remain on the slide. 



Telemann's method is to shake up a small portion of faeces with equal parts 

 of ether and hydrochloric acid, filter, centrifuge, and examine the bottom 

 deposit. 



Bass's method is to dilute the faeces with ten or more times their bulk of 

 water, strain through two or three layers of gauze in a funnel, centrifuge, 

 pour off fluid, fill up with diluted faeces, shake, centrifuge, repeat a third 

 time, then examine deposit removed by a clean pipette. 



It must be admitted, as noted by Miss Porter and other observers, that 

 concentration methods for the detection of ova are of relatively little use, as in 

 practice they take too long. 



Prognosis. — There is no doubt that ankylostomiasis is one of 

 the great factors in producing the death-rate of a tropical native 

 community, very often because it is not diagnosed. Ashford, King, 

 and Gutierrez placed the deaths of Porto Rico caused by ankylosto- 

 miasis at 30 per cent, of the total death-rate, and we are not at all 

 surprised at this, for our experience indicates that the disease is 

 frequently entered in death certificates as anaemia, general dropsy, 

 and malarial cachexia. 



Treatment. — The aim of the treatment is to kill and remove the 

 parasites, and this can be effected by thymol, eucalyptus oil, 

 eucalyptol, beta-naphthol, or male-fern. A case must not be con- 

 sidered cured until the faeces show no ova on repeated examina- 

 tion after two or three weeks. 



In all cases the patient should be carefully examined as to the 

 condition of all his organs before treatment is begun, and should 

 be placed on low or liquid diet for a day or so, and while being 



